脂肪乳与免疫球蛋白在复发性流产保胎中的疗效观察及护理体会

Efficacy and nursing care of intralipid and intravenous immunoglobulin on peripheral blood natural killer cells in women with recurrent spontaneous abortion

目的探讨注射脂肪乳与免疫球蛋白(intravenous immunoglobulin,IVIG)在自然杀伤细胞(natural killer cell,NK cell)升高的复发性流产(recurrent spontaneous abortion,RSA)孕妇中的临床效果及护理体会。方法收集2010年1月至2013年3月因NK细胞升高在江门市妇幼保健计划生育服务中心治疗的RSA孕妇共283例,按照患者意愿选择治疗方案,在孕5周开始分别采用免疫球蛋白治疗(IVIG组,92例),脂肪乳治疗(脂肪乳组,103例)以及常规保胎(常规保胎组,88例),妊娠12周复查NK细胞,比较各组治疗前后外周血NK细胞比例、妊娠成功率以及两种不同注射药物的不良反应。结果IVIG组NK细胞比例为(15.38±3.85)%,脂肪乳组NK细胞比例为(16.10±4.05)%,常规保胎组NK细胞比例为(21.30±4.62)%;IVIG组和脂肪乳组NK细胞比例显著低于治疗前,差异有统计学意义(P<0.05),常规保胎组治疗前后NK细胞比例差异无统计学意义(P>0.05)。IVIG组活产率为81.52%,脂肪乳组活产率为78.64%,常规保胎组活产率为45.45%;IVIG组、脂肪乳组活产率相似,差异无统计学意义(P>0.05);IVIG组、脂肪乳组与常规保胎组相比差异有统计学意义(P<0.05)。静滴IVIG比静滴脂肪乳较少发生不良反应。结论 IVIG和脂肪乳均可降低RSA患者外周血NK细胞比例,提高持续妊娠率,两者疗效相当。静滴IVIG比静滴脂肪乳较少发生不良反应。

Objective To discuss the efficacy and nursing care of intralipid and intravenous immunoglobulin（ IVIG） on peripheral blood natural killer cells in women with recurrent spontaneous abortion（ RSA）. Methods 283 RSA patients with a increase propotion of NK cells in peripheral blood and received therapy in Xinhui People＇s Hospital from January 2010 to March 2013 were including in this study, According to their wishes, they were divided into 3 groups and received different therapies since 5 weeks of gestation： 92 paitens received IVIG threapy（ IVIG group）, 103 patients received intralipid threapy（ intralipid group） and 88 patients received genenral therapy（ control group）. Maternal peripheral blood samples were taken from these patients and the NK cells propotion were detected at 10 weeks of gestation, The propotion of NK cells in peripheral blood, the success rate of pregnancy of 3 groups and the adverse reactions after inject intralipid and intravenous immunoglobulin. Results The propotion of NK cells in peripheral blood were（ 15.38 ± 3.85） % in IVIG group,（ 16.10 ± 4.05） % in intralipid group and（ 21.30 ± 4.62） % in control group, there are significance difference before and after therapy in IVIG group and intralipid group, but no significance difference in control group. the live birth rate of IVIG group, ntralipid group and control group was 81.52%, 78.64% and 45.45%, there is no significance difference between IVIG group and intralipid group（ P 0.05）, there exist significance difference between IVIG group, intralipid group, with control group（ P〈0. 05）. IVIG therapy had less dverse reactions than intralipid therapy. Conlusions Both IVIG and intralipid could be used to reduce the propotion of NK cells in peripheral blood and increse the success rate of pregnancy, and they have no significant advantage over the other. IVIG therapy had less dverse reactions than intralipid therapy.